A 3-year-old male presents to the pediatric emergency room with partial and full thickness burns to 22% of his body. He weighs 16 kg. Using the Pediatric Parkland Formula, calculate the rate for the first 8 hours of fluid resuscitation for this patient. Do not include maintenance fluids.

Choice A reason: Allowing a toddler to touch equipment can reduce fear by familiarizing them with tools, increasing cooperation. Prohibiting this may heighten anxiety, making the assessment more difficult. This approach is not developmentally appropriate for a 2-year-old, who benefits from exploration, making it an incorrect choice.

Choice B reason: Performing the exam on the parent’s lap provides a sense of security for a 2-year-old, reducing anxiety and improving cooperation. Toddlers have separation anxiety and trust familiar caregivers, making this a developmentally appropriate approach that facilitates a successful physical assessment in a pediatric setting.

Choice C reason: Changing the order of the assessment based on the child’s cooperation is effective for 2-year-olds, who may be uncooperative due to fear or developmental stage. Flexibility minimizes distress, starting with less invasive exams (e.g., heart auscultation) before distressing ones, making this a correct and practical approach.

Choice D reason: Using praise during an assessment reinforces positive behavior in 2-year-olds, reducing fear and encouraging cooperation. Positive reinforcement aligns with developmental psychology, building trust and making the experience less stressful, which is essential for successful pediatric assessments, making this a correct and effective strategy.

Choice E reason: Performing ear and throat exams first is invasive and often distressing for 2-year-olds, increasing resistance and anxiety. Starting with less invasive assessments (e.g., listening to the heart) builds trust, making this approach incorrect as it disregards the toddler’s developmental need for a gradual, less threatening examination process.

Choice A reason: Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia, hyperlipidemia, and generalized edema due to glomerular damage, leading to protein loss in urine. This reduces serum albumin, causing fluid shifts into tissues (edema) and elevated cholesterol due to liver compensation. The described lab and clinical findings align perfectly with this diagnosis.

Choice B reason: Acute glomerulonephritis typically presents with hematuria, hypertension, and mild edema, not significant proteinuria or hyperlipidemia. It is often post-infectious (e.g., streptococcal) and involves immune-mediated glomerular inflammation. The described findings of low albumin and high cholesterol are more specific to nephrotic syndrome, making glomerulonephritis less likely.

Choice C reason: Chronic kidney disease may cause proteinuria and edema in advanced stages, but it typically involves elevated creatinine, reduced glomerular filtration rate, and systemic symptoms like fatigue. Hyperlipidemia and hypoalbuminemia are less prominent compared to nephrotic syndrome, making this diagnosis less consistent with the described clinical presentation.

Choice D reason: Urinary tract infections cause dysuria, frequency, and sometimes hematuria, but not significant proteinuria, hypoalbuminemia, hyperlipidemia, or generalized edema. These infections are bacterial and localized, without the systemic protein and lipid imbalances seen in the described case, making this an incorrect diagnosis for the presentation.